Balance exercise program reduced falls in people with MS

Research into MS and quality of life:
Imbalance and its association with risk for falls in people with multiple sclerosis (MS) is well recognised. The aim of this multi-centre, single-blinded single group pre-test post-test trial is to evaluate the effects of a balance exercise program on falls in people with mild-to-moderate multiple sclerosis.

32 adults with MS able to walk 100 meters but unable to maintain 30-second tandem stance with arms alongside the body were enrolled. Thirty-two participants completed the intervention and had complete fall diaries, and 29 of them also attended all test occasions. Eleven had relapsing-remitting MS, 16 secondary, and five primary progressive MS. The aim of the present study was to evaluate the effects of a seven-week twice-weekly group exercise program (CoDuSe) on prospectively reported falls, balance performance, balance confidence, and perceived limitations in walking among patients. The specific hypotheses were that participation would: i) decrease the number of falls and proportion of fallers from a pre-intervention period to a post-intervention period, ii) improve performance on clinically-administered balance measures and self-rated walking and balance-related measures between a pre-intervention test occasion and a test directly after the intervention period, and iii) show continued benefits in that the improvement would be maintained at a follow-up seven weeks after completion of the intervention.

The study sample was derived from a RCT investigating balance exercise, in which the participants were randomized to either an early start or a late start of the intervention. The present study focused on falls and analysed data for those starting the intervention late, enabling a prospective data collection on falls during seven week periods not only during and after the intervention, but also before intervention. In a day-long session, the exercises were tested practically and discussed in depth with the physiotherapists. A manual was printed with descriptions of the exercises in text and illustrations including progression of the exercises. The exercise program was given twice weekly for seven weeks in groups of four to seven people. Each session lasted for 60 minutes, and started with 20 minutes of selected core stability exercises inspired by those described by Freeman et al. (Core Stability Exercise Program).

The physiotherapists initially explained and demonstrated the core muscles and the core stability exercise technique. After training core stability, the participants were encouraged to maintain their focus on core stability when performing the remaining tasks, which covered dual tasking and different sensory conditions. Examples of sensory strategies were using an uneven, soft, or moving surface and/or withdrawing visual input. Each session allowed for approximately five minutes of stretching and/or relaxing at the end. All participants were provided with a printout of the program after the study period. Data on self-reported falls (in- and outdoors) were collected prospectively during three seven week periods. Data on the secondary outcomes were collected at inclusion (T0), immediately after completing the CoDuSe program (T1), and 7 weeks after completion of the program (T2). Balance was measured using the Berg Balance Scale, the Four Square Step Test, the Sit-to-Stand Test, the Timed Up and Go test both alone (TUG) and with cognitive component (TUGcognitive), the Functional Gait Assessment, the 12-item MS Walking Scale (MSWS-12), and the Activities-specific Balance Confidence Scale (ABC).

The results showed a median intervention attendance rate was 12 of 14 sessions. Five persons never attended the exercise group, and two persons attended only once; all seven were excluded. Number of falls (166 to 43; p ≤ 0.001) and proportion of fallers (17/32 to 10/32; p ≤ 0.039) decreased significantly between the pre-intervention and post-intervention periods. Balance performance improved significantly. No significant differences were detected for perceived limitations in walking, balance confidence, the Timed Up and Go test, or Sit-to-Stand Test. Seven weeks of twice-weekly group balance exercises using the CoDuSe program can reduce the number of falls and fallers as well as improve balance performance, but changes in perceived limitation in walking or balance confidence were not captured.

Elisabet NY, Lena Kristina VK
Arch Phys Med Rehabil. 2014 Jul 5. pii: S0003-9993(14)00473-0. doi: 10.1016/j.apmr.2014.06.016. [Epub ahead of print].
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